This form is furnished to give you a statement of actual settlement costs. Pennsylvania Mortgage Deed Template.Complete the "After Recording" and "Prepared By" statements and fill in the name of the county. Download English and Spanish versions of TRID model and sample forms for different loan types. How to Fill Out Blank Mortgage Statement Form. Finance Agency is located in the County of. Do you need a loan payoff request form? A copy of the payoff statement for the first mortgage.