Such proposition shall be submitted to the voters in substantially the following form at such election:

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Shall a sports facility maintenance tax of ______ percent on the amount of sales or charges for all rooms paid by the transient guests of hotels, motels and tourist courts and ______ percent on the gross receipts derived from the retail sales of food at a food establishment be levied in the county of ______ outside the corporate limits of a city with a population of at least three hundred fifty thousand inhabitants to provide funds for the maintenance of sports facilities within the county?
?YES ?NO

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