1104 20th Street, PO Box 566 | Belleville, KS 66935 | 1-785-527-2211
Please complete as much information on the form below as possible and securely submit it to us through our website.
Click the icon on the left for a printable version of this form that you can complete and mail to us, or bring to the funeral home.
Click the Submit Information button below to securely transmit this form to us.
We stand ready to assist you. If a death has occurred, please call us on the number below, or click here.
Close this window