0001213900-22-050821.txt : 20220824 0001213900-22-050821.hdr.sgml : 20220824 20220824170308 ACCESSION NUMBER: 0001213900-22-050821 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220811 FILED AS OF DATE: 20220824 DATE AS OF CHANGE: 20220824 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kim Jay CENTRAL INDEX KEY: 0001935590 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41479 FILM NUMBER: 221192195 MAIL ADDRESS: STREET 1: 6940 BEACH BLVD SUITE D-705 CITY: BUENA PARK STATE: CA ZIP: 90621 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Reborn Coffee, Inc. CENTRAL INDEX KEY: 0001707910 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 474752305 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 17809 GILLETTE AVE CITY: IRVINE STATE: CA ZIP: 92614 BUSINESS PHONE: 949-880-2868 MAIL ADDRESS: STREET 1: 17809 GILLETTE AVE CITY: IRVINE STATE: CA ZIP: 92614 FORMER COMPANY: FORMER CONFORMED NAME: CAPAX INC. DATE OF NAME CHANGE: 20170530 3 1 ownership.xml X0206 3 2022-08-11 0 0001707910 Reborn Coffee, Inc. REBN 0001935590 Kim Jay 580 N. BERRY STREET BREA CA 92821 1 1 1 0 CEO Common Stock 2530333 D /s/ Jay Kim 2022-08-24