Mo. Rev. Stat. § 115.461: Tally book, form of — tally sheet, form of — statements of returns, form of (paper ballots).

1. The tally book for each polling place using paper ballots shall be in substantially the following form:

Tally book for ______ precincts, at the general (special, primary) election held on the ______ day of ______, 20______ AB, CD, EF, and XP judges, and ZR and LT, watchers and BH and SP challengers at this polling place, were sworn as the law directs before beginning their duties.

We hereby certify:

The number of ballots received at this polling place is ______;

The information on the official ballots received at this polling place is the same as the information on the sample ballots received at this polling place.

AB

CD Election Judges

EF

XP

We hereby certify:

The number of ballots cast at this polling place is ______;

The number of identification certificates signed at this polling place is ______;

The number of rejected ballots at this polling place is ______;

The number of spoiled ballots at this polling place is ______;

The number of ballots received at this polling place which were not cast at this election is ______;

AB

CD

EF

XP

2. At each polling place using paper ballots, two tally sheets shall be included in each tally book. The tally sheets shall be in substantially the following form:

NAMES OF PERSONS VOTED FOR AND

FOR WHAT OFFICE AND THE NUMBER

OF VOTES CAST FOR EACH PERSON

Office Candidates Tally of Votes Total Votes

MC

Governor HK

EH

Representative SS

in RK

Congress CB

VOTES FOR AND AGAINST EACH QUESTION

Question Tally of votes FOR Tally of votes AGAINST Total of votes FOR Total of votes AGAINST

1. To_____

______

______

2. To_____

______

__________________ __________________

Signature of Recording Signature of Recording

Judge Judge

(of different political party)

3. At each polling place using paper ballots, two statements of returns shall be provided to the election judges. The statements of returns shall be in substantially the following form:

We hereby certify that MC had ______ votes for governor, and HK had ______ votes for governor and EH had ______ votes for governor; that SS had ______ votes for representative in Congress, etc.

We hereby certify that proposition number 1 received ______ votes for and ______ votes against; constitutional amendment number 1 received ______ votes for and ______ votes against, etc.

We, the duly qualified and acting Judges of the polling place for ______ precincts, at the general (special, primary) election held on the ______ of ______, 20______, in ______ county (City of St. Louis, Kansas City), Missouri do hereby certify that the foregoing is a full and accurate return of all votes cast at this polling place for all candidates and for and against all questions.

AB

CD Election Judges

EF

XP