1. Complete the Payoff Request Form in its entirety. Unsigned or incomplete requests will not be processed. 2.This form is furnished to give you a statement of actual settlement costs. Edit, sign, and share sample payoff letter for private mortgage online. No need to install software, just go to DocHub, and sign up instantly and for free. Log into MassTaxConnect account. Select Request a Certificate of Good Standing. A payoff statement should include the name and address of the lender preparing the statement and be addressed to the lender that requested the payoff. How to fill out the Mortgage Payoff Statement Request Form? Copies of Form 1098: Mortgage Interest Statement.