How to understand City of Philadelphia judgment and lien numbers in order to submit a payoff request. 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.To get a mortgage payoff statement, you'll need to contact your lender and provide some personal info. A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. This form is furnished to give you a statement of actual settlement costs. Your payoff amount and a good-through date will be displayed in the payoff form. How to fill out the Mortgage Payoff Statement Request Form? How To Guide Tips for completing required Borrowing Documents. Information on completing the Form 8802, Application for United States Residency Certification. Can I sign up to have my bill automatically deducted from my bank account?