Ballot results for the candidate by precinct
| Candidate | Formella Marian Jan |
| Age | 56 |
| Address and endorsements | Dzierzgoń |
| Constituency no. | 1 |
| Number of votes for the candidate | 26 |
| % of valid votes for the candidate | 0.79% |
| Number of votes for the list | 339 |
| % of votes for the candidate relating to votes for the list | 7.67% |
| Mandate | No |
gm. Dzierzgoń
| No. | Address | Number of votes | % of valid votes* | Number of votes for the list | % of votes for the candidate relating to votes for the list * |
|---|---|---|---|---|---|
| 1 | Szkoła Podstawowa Nr 1 ul. Krzywa 17 Dzierzgoń | 3 |
0.34% 
|
70 |
4.29%
|
| 2 | Sala Sportowa Zespołu Szkół ul. Zawadzkiego 15 Dzierzgoń | 20 |
1.71%
|
105 |
19.05%
|
| 3 | Świetlica Nowiec 6, | 2 |
1.79%
|
12 |
16.67%
|
| 4 | Szkoła Podstawowa Bągart 3 | 0 | — | 66 |
0.00%
|
| 5 | Świetlica Jasna 17 | 0 | — | 44 |
0.00%
|
| 6 | Świetlica Żuławka Sztumska 25 | 0 | — | 16 |
0.00%
|
| 7 | Szkoła Podstawowa Bruk 1 | 0 | — | 9 |
0.00%
|
| 8 | Świetlica Ankamaty 1 | 1 |
0.83%
|
4 |
25.00%
|
| 9 | Świetlica Stanowo 1 | 0 | — | 12 |
0.00%
|
| 10 | Świetlica Tywęzy 16 | 0 | — | 1 |
0.00%
|