TO: Enter the name of the party requesting loan balance
Enter first line of address of party requesting balance
Enter second line of address of party requesting balance
Enter final line of address of party requesting balance
REGARDING: Enter the name of the borrower
Property located at: Enter address of property
Enter the city, state of residence of borrower
The balance due upon this mortgage as of Enter the date of preparation of estoppel is $ Enter the loan balance (Enter the loan balance dollars). The per diem is $ Enter the per diem (Enter the per diem dollars). The mortgage was last paid on Enter the date of last payment.
The figures in this estoppel are effective until Enter last date when pay off is correct.
For: Enter name of owner of the loan
As: Enter title of the person providing estoppel
Enter address of loan owner
Enter the city, state of loan owner