| m. Człuchów, Precinct no. 5, Constituency no. 4 | |
| Constituency | Constituency no. 4 |
| Precinct | Precinct no. 5 |
| Electoral Commission Regional Headquarters | Szkoła Podstawowa Nr 1, ul. Średnia 4a, 77-300 Człuchów |
| Number of electors | 1 852 |
| Number of dispensed ballot cards | 276 |
| Number of valid ballot cards | 276 |
| Number of votes valid | 273 |
| Number of votes invalid | 3 |
| Number of dispensed ballot cards for plenipotentiaries | 0 |
| Protocol date | 01-04-2012 22:51 |
| List no. 1 - KOMITET WYBORCZY CZŁUCHOWSKIE FORUM SAMORZĄDOWE | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Ziemba-Lacroix Małgorzata Beata | 28 | 10,26% | |
| List no. 2 - KOMITET WYBORCZY WYBORCÓW Wojciecha Mroziewicza | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Mroziewicz Wojciech Józef | 35 | 12,82% | |
| List no. 3 - KOMITET WYBORCZY WYBORCÓW ZGODA BUDUJE CZŁUCHÓW | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Meller Marcin | 43 | 15,75% | |
| List no. 4 - KOMITET WYBORCZY WYBORCÓW Mirosława Szałaty | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Szałata Mirosław Waldemar | 44 | 16,12% | |
| List no. 5 - KOMITET WYBORCZY WYBORCÓW CZŁUCHÓW SILNY GOSPODARCZO | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Neckar Irena | 42 | 15,38% | |
| List no. 6 - KOMITET WYBORCZY WYBORCÓW - Bogusławy Konczanin | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Konczanin Bogusława | 21 | 7,69% | |
| List no. 7 - KOMITET WYBORCZY WYBORCÓW Wojciecha Podgórskiego | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Podgórski Wojciech | 28 | 10,26% | |
| List no. 8 - KOMITET WYBORCZY WYBORCÓW CZŁUCHOWSKA INICJATYWA OBYWATELSKA | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Kopczyński Adam Jerzy | 32 | 11,72% | |