State Home Mortgage Official Payoff Request form . This form is furnished to give you a statement of actual settlement costs.The mortgage payoff calculator helps you find out. A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. Do you need a loan payoff request form? There's probably an online form. The mortgage statement must be in the name of the homeowner living in the home, or in the name of the borrower or spouse living in the home with the homeowner. A copy of the Good Faith Estimate or estimated settlement statement from the lender. Payoff good thru date. Associates to obtain your mortgage payoff information from your lenders.