The ballot for the election shall be printed to permit voting for or against the proposition: “The conversion of the __________ County Public Hospital District No. _____ (name of district) from a district operating under Chapter 282, Health and Safety Code, to a district operating under Article IX, Section 9, of the Texas Constitution, and the levy of annual taxes for hospital purposes at a rate not to exceed _______ (insert amount not to exceed 75 cents) on each $100 valuation of all taxable property in the district.”