Payoff requests are answered within 1-2 days when received on the Download this pdf file. State Home Mortgage Official Payoff Request form.This form is furnished to give you a statement of actual settlement costs. A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. If you need a template, click here to download borrower authorization template. 20 MB max file size. If you need a template, click here to download borrower authorization template. 20 MB max file size. Please click on the link below containing the Water Sewer Request for Statement of Charges Form. This form is a statement of final loan terms and closing costs.