Mortgage Payoff Form Your Name:* First Last Your Soc. Security NumberYour Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your 1st Telephone #:*Type:*WorkMobileHomeFaxPagerOtherYour 2nd Telephone #:Type:WorkMobileHomeFaxPagerOtherYour email address:* First MortgageLender Name:Loan/Account #:Lender Telephone #:Equity/Second MortgageLender Name:*Loan/Account #:*Lender Telephone #:To the Lender: Please consider this a formal request for a payoff figure relating to the above referenced loan. The payoff figure should be good through:Date MM slash DD slash YYYY I understand that there may be a fee for this service. If the loan is a line of credit that will be closed, please freeze the account; I understand that no further advances will be honored, and that the account will be closed. Please provide the payoff information to: David R. Rocheford, Jr. Attorney at Law 156 Hamilton St. Leominster, MA 01453 Fax: (978) 383-5511 Tel: (978) 847-0104 Special comments, instructions or questions:Captcha
