1) North Carolina General Statutes §45-36.9 requires that you must submit a satisfaction instrument to the. (f) A payoff statement or a short-pay statement may contain the amount of any fees authorized under this section not included in the payoff amount.This form is furnished to give you a statement of actual settlement costs. If you have filed a tax return, and cannot pay the tax due in full, you may be eligible to request an installment payment agreement. Do you need a loan payoff request form? If you have filed a tax return, and cannot pay the tax due in full, you may be eligible to request an installment payment agreement. For an official statement verifying your existing mortgage balance, monthly payments, and any late payments, please complete a 3rd Party Authorization form. (f). A payoff statement or a short‑pay statement may contain the amount of any fees authorized under this section not included in the payoff amount. Mortgage Assistance Application. Completing this form is among the first steps to addressing challenges you may be having with your mortgage payments.