| gm. Dzierżoniów, Precinct no. 5, Constituency no. 5 | |
| Constituency | Constituency no. 5 |
| Precinct | Precinct no. 5 |
| Electoral Commission Regional Headquarters | Zespół Szkolno-Przedszkolny, ul. Główna 50, 58-241 Piława Dolna |
| Number of electors | 1 264 |
| Number of dispensed ballot cards | 290 |
| Number of valid ballot cards | 290 |
| Number of votes valid | 290 |
| Number of votes invalid | 0 |
| Number of dispensed ballot cards for plenipotentiaries | 0 |
| Protocol date | 19-02-2012 22:31 |
| List no. 1 - KOMITET WYBORCZY WYBORCÓW TEODORY SKUTNIK | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Skutnik Teodora Janina | 74 | 25,52% | |
| List no. 2 - KOMITET WYBORCZY WYBORCÓW PAWŁA MICHAŁOWSKIEGO | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Michałowski Paweł | 33 | 11,38% | |
| List no. 3 - KOMITET WYBORCZY WYBORCÓW ELŻBIETY SAK | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Sak Elżbieta | 51 | 17,59% | |
| List no. 4 - KOMITET WYBORCZY WYBORCÓW KRZYSZTOFA TWARDAKA | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Twardak Krzysztof Tomasz | 132 | 45,52% | |