Payoff Statement (1) - Free download as PDF File (. How to fill out the Payoff Request Letter Templates?This document is a debt payoff letter from a debtor to a creditor. The pay statement provides details about your current and year-to-date earnings, taxes, deductions, and accrued leave time. You need to have all the information. This includes the name and address of the lender as well as the borrower. How can I request a payoff statement? Contact your servicing bank (where you make your monthly mortgage payments) and request a payoff statement. Small enough to know you. Large enough to help you.