Please accept this as my authorization to issue a payoff statement to. Through an effective date of .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. Value of Real Property or Mortgage Foreclosure Claim You must fill out and submit this form with each new action. Developer shall completely and accurately fill out and file forms DSA 6-C or. Mike Beltran, Lithia. 58.