Vitals Form

This form will be used to complete the death certificate. All required items are identified with an asterisk. If you do not have the complete information, please type unknown in the field and we will get the information at a later time.



Please fill out the information below and click “Submit” when you are finished.


The Amos Family
Phone: (913) 631-5566
Fax: (913) 631-2236
10901 Johnson Dr., Shawnee, KS 66203

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