Mo. Rev. Stat. § 198.260: Form of ballot.

The question of whether or not a nursing home shall be organized shall be submitted in substantially the following form:

Shall there be organized in the counties of ______ , state of Missouri, a nursing home district for the establishment and operation of a nursing home to be located within the boundaries of the proposed district and having the power to impose a property tax not to exceed the annual rate of thirty-five cents on the hundred dollars assessed valuation without voter approval, and such additional tax as may be approved hereafter by vote thereon, to be known as "______ Nursing Home District" as prayed for by petition filed with the county clerk of ______ County, Missouri, on the ______ day of ______, 20______?