Rules for Missouri Ambulance Districts

IV. Referendum, Initiative and Recall

Referendum and initiative

Voters of an AD may petition for only four specific referendum purposes: AD director recall and removal from office (see Recall and exemptions in this chapter), annexation of land into the AD (190.070), consolidating two or more ADs into a single AD (190.090) and expansion of AD boundaries for a whole city for a city in both Franklin and St. Louis counties (190.087). (See Chapter VII. Changing AD Boundaries for more information on petition process for the latter three purposes.)

Unlike fire protection districts, statutes do not allow initiative referendums, where the voters act on behalf of the board or reverse any action taken by the AD board.


Forms for the three speciifc referendum petitions are provided in the statutes. Generally petitioners are warned that it is a felony to sign someone else’s name, sign more than once or sign without being a registered voter. The petitions state that the persons undersigned order the described measure be referred to the people of the AD for approval or rejection. The measure that petitioners want adopted is then described in the petition. Each person signs on a numbered line and gives his or her voting address. Each sheet of signatures must have a sworn oath by the signature gatherer at the bottom, verifying that the persons listed signed the petition in the gatherer’s presence and that the gatherer believes they are all registered voters who reside in the AD. The form must be notarized.

If the petition is in compliance with the law, which includes signature veriifcation, the issue goes before the voters. A simple majority vote adopts the proposed measure that was in the referendum petition.

The petition process should be taken seriously. In one known instance, the description of what petitioners proposed was faulty, even though they had paid for legal advice to help prepare the petition, and so the issue never came to the ballot. In addition, when the signatures were being verified, at least eight names were found that did not match those of AD residents or registered voters. The felony warning noted above is a felony election offense. Conviction of such a violation permanently severs a citizen’s voting rights. Had the issue on the petition gone to the ballot, eight persons could have permanently lost their right to vote.

Recall and exemptions

Any or all of the members of an AD board are subject to recall and removal from office by AD voters subject to several restrictions listed below under Who may not be recalled. Although recall is rare, it has been used successfully, so a board should be familiar with the rules that govern it (190.056).

Who may not be recalled

Board members are exempt from recall during the first 180 days and the final 180 days of their terms. If a member has been the subject of a recall election during the term and survived, that member is exempt for the rest of that term. This means all board members are subject to being recalled by AD voters if they are not in the first half of their first year or the last half of their final year, or unless they have survived a recall vote that term.

Notice of intent

A notice of the intention to circulate a recall petition must be either handed personally to, or sent by certified mail to, the board member who is the subject of the recall. A copy is filed with the election authority along with a sworn statement that the notice was served on the board member. Each member whose removal is sought must receive a separate notice.

The notice must contain the board member’s name, a statement of 200 words or less stating the reasons for the proposed recall, and names and addresses of one to five recall proponents. The board member has seven days to file a response with the election authority, and if a response is filed, the board member must send a copy to at least one proponent by certified mail.

Recall petitions include a request for election, a copy of the intention’s complaint, the member’s response or a note that no response was made, and lines for each signer’s signature, printed name and address. Each petition requires a sworn certiifcation from the signature gatherer and must be completed and turned in within 180 days from the date of filing the notice of intent.

The signatures must equal at least 25% of the people who voted for governor within the AD in the last general election. The election authority has 20 days to verify signatures. If signatures fall short of the required total, petitioners have 10 days to collect more. If numbers are still insufficient, no action is taken and the petition stays on file with the election authority.

If enough signatures are gathered, a certificate is sent to the AD board before its next meeting with the board member’s name, the number of signatures required, the total number of signatures on the petition and the number that were valid. Upon proof that the board has received the certificate, the election authority schedules the election for a regular election day (115.123). Up to 42 days before the election, the member can resign and have the question removed from the ballot. The resigned member may not be appointed to the vacancy (190.056.14).

Once the recall election has been scheduled, candidate(s) to replace the board member if he or she is recalled nominate themselves by filing a statement of candidacy with the election authority. For more information on AD director qualifications, see Chapter III. Officials and Board Operations.

Costs of the recall election are billed to the AD. The election must be held no less than 45 days and no more than 120 days after the AD board receives the recall petition. Because the law (115.123) restricts the days on which elections may be held, determine possible dates for the election as soon as a notice of intent has been filed. A simple majority decides the recall question. One more than half of the total votes cast ousts the member. One vote short of half the total, and the board member stays.

Change in number of board members

The law (190.051.1) allows a fifth referendum on the number of AD board members, but this referendum does not require a voter petition because it is a six-member AD board that asks the voters to approve an “at-large” seventh board member. The same law also allows a six-member AD board to ask the voters to approve decreasing the AD board to five or three members.

If a majority of the AD voters agree to add a seventh AD board member, then at the next election of AD board members, the AD voters at-large select the seventh AD board member (190.051.2).

If a majority of the AD voters agree to decrease the number of board members, the county clerk redraws the AD into the resulting number of election subdistricts with equal population bases. Within 90 days, the AD holds elections by election subdistricts similar to the election for the initial AD board  that is, election subdistricts are numbered from one to three (or five) and members serve staggered terms (190.050).  At all later elections the member elected from each subdistrict serves for three years, etc. (190.051.3).

Members of the AD board of directors in office on the date of an election to decrease the number of board members must still serve the term to which they were elected or appointed until their successors are elected and qualified (190.051.4).