Mo. Rev. Stat. § 206.070: Form of ballot.

The question shall be submitted in substantially the following form:

Shall there be organized in the counties of ______, state of Missouri, a hospital district for the establishment and operation of a hospital to be located at* ______ in ______ County, Missouri, and having the power to impose a property tax not to exceed the annual rate of fifty 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 "______ Hospital District", as prayed for by petition filed with the county clerk of ______ County, Missouri, on the ______ day of ______, 20______?