0001829126-24-007365.txt : 20241108 0001829126-24-007365.hdr.sgml : 20241108 20241108154331 ACCESSION NUMBER: 0001829126-24-007365 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20241108 DATE AS OF CHANGE: 20241108 EFFECTIVENESS DATE: 20241108 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provenance Blockchain Labs, Inc. CENTRAL INDEX KEY: 0002043053 ORGANIZATION NAME: IRS NUMBER: 991562945 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-529018 FILM NUMBER: 241440238 BUSINESS ADDRESS: STREET 1: 36 BEACH ROAD, #178 CITY: MONMOUTH BEACH STATE: NJ ZIP: 07750 BUSINESS PHONE: (860) 543-1406 MAIL ADDRESS: STREET 1: 36 BEACH ROAD, #178 CITY: MONMOUTH BEACH STATE: NJ ZIP: 07750 D 1 primary_doc.xml X0708 D LIVE 0002043053 Provenance Blockchain Labs, Inc. 36 BEACH RD #178 MONMOUTH BEACH NJ NEW JERSEY 07750 917-476-2790 DELAWARE None None Corporation true 2024 Anthony Moro 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Executive Officer Director Dan Garzia 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Executive Officer Ira Miller 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Executive Officer Other Technology No Revenues 06b false 2024-10-25 false true false 1 15000200 15000200 0 true 2 9 0 0 0 false Provenance Blockchain Labs, Inc. /s/ Anthony Moro Anthony Moro CEO 2024-11-08