Mo. Rev. Stat. § 190.052: Board member must live in district — vacancies, how filled.

Any member of the board of directors who moves residency from the district shall be disqualified as a member of the board. If one or two vacancies occur in the membership of the board as a result of death, resignation, or disqualification, the remaining members shall appoint one or two qualified persons, as provided in section 190.050, to fill the vacancies until the end of the unexpired term. Such appointment shall be made with the consent of a majority of the remaining members of the board. If the board is unable to agree in filling a vacancy, the county commission, upon the written request of a majority of the remaining board members or the ambulance service administrator, as described in section 190.112, shall within thirty calendar days fill them by appointment of qualified persons, as provided in section 190.050, and shall notify the persons in writing of their appointment. The persons appointed shall serve for the unexpired term.