Ballot results for the candidate by precinct
| Candidate | Fornalska Urszula |
| Age | 50 |
| Address and endorsements | Lasówka |
| Constituency no. | 4 |
| Number of votes for the candidate | 4 |
| % of valid votes for the candidate | 0.21% |
| Number of votes for the list | 47 |
| % of votes for the candidate relating to votes for the list | 8.51% |
| Mandate | No |
gm. Bystrzyca Kłodzka
| 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 * |
|---|---|---|---|---|---|
| 11 | Wiejski Dom Kultury w Starej Bystrzycy | 2 |
0.39% 
|
19 |
10.53%
|
| 12 | Specjalny Ośrodek Szkolno-Wychowawczy w Długopolu Zdroju ul.Zdrojowa 11 | 0 | — | 15 |
0.00%
|
| 13 | Budynek byłej Szkoły Podstawowej w Międzygórzu, ul. Pocztowa 1 | 0 | — | 5 |
0.00%
|
| 14 | Szkoła Podstawowa w Wilkanowie | 2 |
0.38%
|
8 |
25.00%
|