Ballot results for the candidate by precinct
| Candidate | Fornal Romana |
| Age | 39 |
| Address and endorsements | Sulmierzyce |
| Constituency no. | 3 |
| Number of votes for the candidate | 68 |
| % of valid votes for the candidate | 25.09% |
| Number of votes for the list | 0 |
| % of votes for the candidate relating to votes for the list | — |
| Mandate | No |
m. Sulmierzyce
| 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 | Zespół Szkół Publicznych w Sulmierzycach ul. Szkolna 2 | 68 |
25.09% 
|
278 |
24.46%
|