Ballot results for the candidate by precinct
| Candidate | Burchard Maria Helena |
| Age | 51 |
| Address and endorsements | Tomaszów Mazowiecki |
| Constituency no. | 1 |
| Number of votes for the candidate | 180 |
| % of valid votes for the candidate | 3.78% |
| Number of votes for the list | 1327 |
| % of votes for the candidate relating to votes for the list | 13.56% |
| Mandate | No |
m. Tomaszów Mazowiecki
| 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 | J & K Romstom, ul.Barlickiego 33 | 9 |
2.76% 
|
81 |
11.11%
|
| 2 | Miejski Ośrodek Pomocy Społecznej, ul. Ks. Skorupki 1/3 | 24 |
2.85%
|
292 |
8.22%
|
| 3 | Przedszkole Nr 12, ul. Kombatantów 1/3 | 49 |
5.34%
|
275 |
17.82%
|
| 4 | Gimnazjum nr 2 ul. Warszawska 95 | 33 |
3.87%
|
197 |
16.75%
|
| 5 | Zespół Szkół Nr 4 (dawna Szkoła Podstawowa Nr 10),ul. Ostrowskiego 14 | 43 |
4.37%
|
253 |
17.00%
|
| 6 | Świetlica FD Weltom, ul. Gen.Hallera 2 | 18 |
4.81%
|
106 |
16.98%
|
| 7 | Gimnazjum Nr 3, Al.Piłsudskiego 42 | 4 |
0.94%
|
106 |
3.77%
|
| 38 | Dom Pomocy Społecznej, ul. Farbiarska 27/29 | 0 | — | 17 |
0.00%
|