Ballot results for the candidate by precinct
| Candidate | Cupała Urszula Teresa |
| Age | 37 |
| Address and endorsements | Sarnowo |
| Constituency no. | 3 |
| Number of votes for the candidate | 40 |
| % of valid votes for the candidate | 1.50% |
| Number of votes for the list | 553 |
| % of votes for the candidate relating to votes for the list | 7.23% |
| Mandate | No |
gm. Kozłowo
| 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 | Dom Kultury w Kozłowie | 20 |
2.00% 
|
184 |
10.87%
|
| 2 | Szkoła Podstawowa w Zaborowie | 12 |
2.99%
|
40 |
30.00%
|
| 3 | Szkoła Podstawowa w Szkudaju | 4 |
1.83%
|
53 |
7.55%
|
| 4 | Gimnazjum w Szkotowie | 3 |
0.53%
|
146 |
2.05%
|
| 5 | Szkoła Podstawowa w Rogożu | 1 |
0.21%
|
130 |
0.77%
|