0001829126-24-007825.txt : 20241126 0001829126-24-007825.hdr.sgml : 20241126 20241126094440 ACCESSION NUMBER: 0001829126-24-007825 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20241126 DATE AS OF CHANGE: 20241126 EFFECTIVENESS DATE: 20241126 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: 021-530487 FILM NUMBER: 241498675 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 Alfred M. Macdaniel, Jr. 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Director Dr. Sachin Jaitly 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Director June Ou 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Director Mike Cagney 36 Beach Rd #178 Monmouth Beach NJ NEW JERSEY 07750 Director Other Technology No Revenues 06b false 2024-11-12 false true false 100000 10000000 2650000 7350000 false 14 0 0 0 false Provenance Blockchain Labs, Inc. /s/ Anthony Moro Anthony Moro CEO 2024-11-26