Ballot results for the candidate by precinct
| Candidate | Chowaniec-Samson Jadwiga |
| Age | 37 |
| Address and endorsements | Podbrzezie Dolne |
| Constituency no. | 3 |
| Number of votes for the candidate | 35 |
| % of valid votes for the candidate | 12.73% |
| Number of votes for the list | 0 |
| % of votes for the candidate relating to votes for the list | — |
| Mandate | No |
gm. Kożuchów
| 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 * |
|---|---|---|---|---|---|
| 4 | Kożuchowski Ośrodek Kultury i Sportu "ZAMEK" Kożuchów ul. Klasztorna | 35 |
12.73% 
|
35 |
100.00%
|