Payoff requests, including borrower's authorization, should be directed to the servicer of the first mortgage. 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. It typically details the principal balance, interest due as of that date, per diem, any late fees, etc. Do you need a loan payoff request form? View a Sample Settlement Statement to learn more about what to expect at settlement and to familiarize yourself with the language and terms of settlement. Montgomery County does not require any further action after the payoff of a mortgage loan.