Ballot results for the candidate by precinct
| Candidate | Forycka Bożena |
| Age | 50 |
| Address and endorsements | Dobrzyca |
| Constituency no. | 3 |
| Number of votes for the candidate | 24 |
| % of valid votes for the candidate | 0.88% |
| Number of votes for the list | 108 |
| % of votes for the candidate relating to votes for the list | 22.22% |
| Mandate | No |
gm. Dobrzyca
| 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 | Dobrzyca-Gminne Centrum Kultury, mała sala - ul. Koźmińska 10 | 4 |
0.81% 
|
26 |
15.38%
|
| 2 | Galew 38 - Szkoła Podstawowa | 3 |
0.85%
|
27 |
11.11%
|
| 3 | Koźminiec 52 - Szkoła Podstawowa | 8 |
3.15%
|
16 |
50.00%
|
| 4 | Sośnica 84 - Szkoła Podstawowa | 0 | — | 2 |
0.00%
|
| 5 | Fabianów - sala wiejska, ul. Przemysłowa 3 | 5 |
1.72%
|
18 |
27.78%
|
| 6 | Dobrzyca - Gminne Centrum Kultury, duża sala - ul. Koźmińska 10 | 2 |
0.24%
|
11 |
18.18%
|
| 7 | Karmin 25 - Szkoła Podstawowa | 2 |
0.81%
|
8 |
25.00%
|
| 8 | Fabianów - Dom Pomocy Społecznej ul. Pleszewska 2 | 0 | — | 0 | — |