Title No. STATE OF NEW YORK : : ss. What you get: Instant access to fillable Microsoft Word or PDF forms.Minimize the risk of using outdated forms and eliminate rejected fillings. This form is furnished to give you a statement of actual settlement costs. Attach payoff statements and copies of checks. Include satisfactions if available. A payoff letter shows the remaining balance on your mortgage, including fees, interest, etc. Learn more about what a payoff quote is and how to request one. 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.