This is a request for assessment payoff information related to the property described below. This form is furnished to give you a statement of actual settlement costs.Information and instructions, including forms for Uniform Commercial Code (UCC) filings with the Utah Division of Corporations and Commercial Code. Be sure to write your name and court number on your check or money order and include your statement coupon with your payment. Search our library of forms. A 10 day payoff is crucial to getting your old loans paid off during a refinance. Learn how it works from start to finish. This form is a statement of final loan terms and closing costs. Compare this document with your Loan Estimate. How do I request a Payoff Statement?