Form
(Rev. March 2024)
W-9 Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
Department of the Treasury
Go to www.irs.gov/FormW9 for instructions and the latest information. send to the IRS.
Internal Revenue Service
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded
entity’s name on line 2.)
Flock Group, Inc.
2 Business name/disregarded entity name, if different from above.
Flock Safety
See Specific Instructions on page 3.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check 4 Exemptions (codes apply only to
only one of the following seven boxes. certain entities, not individuals;
see instructions on page 3):
Individual/sole proprietor ✔ C corporation S corporation Partnership Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . . Exempt payee code (if any)
Print or type.
Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate Exemption from Foreign Account Tax
box for the tax classification of its owner. Compliance Act (FATCA) reporting
Other (see instructions) code (if any)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification,
(Applies to accounts maintained
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
outside the United States.)
this box if you have any foreign partners, owners, or beneficiaries. See instructions . . . . . . . . .
5 Address (number, street, and apt. or suite no.). See instructions. Requester’s name and address (optional)
Po Box 121923 (REMITTANCE) 1170 Howell Mill Rd NW Ste 21
6 City, state, and ZIP code
Dallas TX 75312-1923 Atlanta GA 30318
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other – –
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
or
TIN, later.
Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter. 8 2 – 0 5 9 4 8 7 5
Part II Certification
Under penalties of perjury, I certify that:
- The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
- I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
- I am a U.S. citizen or other U.S. person (defined below); and
- The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here
Signature of Mark Smith
U.S. person Mark Smith (Jan 23, 2025 12:09 PST) Date 01/23/2025
New line 3b has been added to this form. A flow-through entity is
General Instructions required to complete this line to indicate that it has direct or indirect
Section references are to the Internal Revenue Code unless otherwise foreign partners, owners, or beneficiaries when it provides the Form W-9
noted. to another flow-through entity in which it has an ownership interest. This
Future developments. For the latest information about developments change is intended to provide a flow-through entity with information
related to Form W-9 and its instructions, such as legislation enacted regarding the status of its indirect foreign partners, owners, or
after they were published, go to www.irs.gov/FormW9. beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
What’s New partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the Purpose of Form
appropriate box for the tax classification of its owner. Otherwise, it
should check the “LLC” box and enter its appropriate tax classification. An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they