Missouri Form 4201 – Assignment of Securities (Fillable PDF)

Form 4201 is the Missouri Department of Revenue’s official Affidavit for Assignment of Securities. This fillable PDF lets you complete the form online, save a copy, and submit it without printing.

What Is Form 4201?

Form 4201 records the transfer of securities (such as stocks, bonds, or other financial instruments) from one party to another for tax purposes. The Missouri Department of Revenue uses it to verify the assignment and ensure proper reporting.

Who Needs to File Form 4201?

• Individuals or entities assigning securities that are subject to Missouri tax.
• Trustees, executors, or legal representatives handling a transfer.
• Businesses that need to document a securities assignment on their state tax return.

How to Complete the Fillable PDF

Instead of downloading the PDF and opening a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load directly in your browser.

1. Click Fill out this form.
2. Wait a few seconds for the Formize PDF Filler to appear.
3. Enter the required information in each highlighted field.
4. Use the built‑in validation to check for missing or incorrect entries.
5. When finished, click Download Completed PDF or Submit as instructed.

Common Mistakes & Tips

• Missing signatures: The form requires a signature from the assignor; the filler lets you type a digital signature.
• Incorrect dates: Use the format MM/DD/YYYY.
• Wrong security description: Provide the full legal name and identification number.
• Double‑check the “Assignment Amount” field for accuracy before saving.

Where to Submit the Completed Form

After saving the completed PDF, mail or fax it to the Missouri Department of Revenue address shown on the form, or upload it through the department’s online portal if you have an account.

Need help? Review the instructions on the form itself or contact the Missouri Department of Revenue directly.