DATE
Servicer's Name
Servicer's Address TILA and Payoff Request 131(f)
Servicer's City, State, Zip Code
CERTIFIED MAIL RETURN RECEIPT REQUESTED
Re: BORROWER'S NAME
Address of Property Encumbered by Mortgage
Transaction Dated: (Date of Note & Mortgage)
Originating Lender: (Lender Named on Note)
Current Servicer: (Refer to Monthly Mortgage Statement)
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