Your mortgage statement contains important information about your loan balance and monthly payments. See what's included in this guide.You can find a sample form here. What's on a Mortgage Interest Statement. There are several key elements to set up in the document at the start of the paper. Our goal is to create a statement that is easy to understand and that provides information to borrowers about current and past payments. A sample worksheet will assist you in making the appropriate calculations. 2. Mail the following items to: City of Chicago. Basic Mortgage Statement Template 2 - Free download as PDF File (. How do I fill this out?