It lays out each fee and dollar still due before you completely pay off your mortgage. Here's how it works.This form is furnished to give you a statement of actual settlement costs. Include your case number, the date of the payoff and your email address in your request. We will email the payoff statement to you upon receiving your request. We request you furnish our office a written payoff with per diem, please fax the payoff as soon as possible to (352)282-4895. This guide will help you learn mortgage math, allowing you to confidently calculate how much you need to pay off your mortgage. Ready to Pay Off Your Home Loan Early? Do you need a loan payoff request form? This is a sample Florida mortgage payoff authorization form and should not be used or relied upon for any real estate transaction.