Missouri Department of Revenue - Motor Vehicle Forms · Missouri state form
Form 4201 Affidavit for Assignment of Securities
Form 4201 assigns securities to the Department of Revenue as collateral for a $75,000 deposit and includes an affidavit that must be sworn before a notary.
- What this form is
- Use Form 4201 to assign securities or a certificate of deposit to the Department of Revenue as collateral for a $75,000 deposit. The form includes information about the securities and their identifying number, an assignment acknowledgment, and a bank official’s acknowledgment. The signer declares the information is true, complete, and correct under penalties of perjury, and must sign before a notary.
- Who needs it
- A person assigning securities to the Department of Revenue as collateral for the required $75,000 deposit needs this form, including a bank official’s acknowledgment.
- Why it needs a notary
- The signer must swear to the affidavit before a notary. This can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form to the Driver License Bureau, 301 West High Street, Room 470, P.O. Box 200, Jefferson City, MO 65105-0200.
Questions
What is Form 4201 used for?
Form 4201 assigns securities or a certificate of deposit to the Department of Revenue as collateral for a $75,000 deposit. It also includes a bank official’s acknowledgment.
Does Form 4201 need to be notarized?
Yes. The signer must swear to the affidavit before a notary. Online notarization is available with a commissioned online notary.
Where do I mail Form 4201?
Mail the completed form to the Driver License Bureau, 301 West High Street, Room 470, P.O. Box 200, Jefferson City, MO 65105-0200.