This is an example of a payoff letter used in a syndicated loan transaction. This payoff letter (including the defined terms such as Lenders,.Please accept this as my authorization to issue a payoff statement to. Through an effective date of . Using the Original Mortgage or a Certified Copy. A mortgage payoff letter can come in two forms. One form tells borrowers the remaining principal amount and interest they have to pay to close out the loan. Under clause 1 of rule XXII, private bills and resolutions were introduced and severally ref erred as follows: By Mr. ANGELL: H. R. 7162. Sample Forms These sample forms may be useful when filing documents for the civil and family courts. If you have any questions, consult an attorney.