| gm. Jarocin, Precinct no. 21 |
| Vote on 26-02-2012 | |
| Precinct | Precinct no. 21 |
| Electoral Commission Regional Headquarters | Szpital Powiatowy w Jarocinie Sp. z o.o., ul. Szpitalna 1, 63-200 Jarocin |
| Number of electors | 33 |
| Number of dispensed ballot cards | 15 |
| Number of valid ballot cards | 15 |
| Number of votes valid | 15 |
| Number of votes invalid | 0 |
| Number of dispensed ballot cards for plenipotentiaries | 0 |
| Protocol date | 26-02-2012 22:00 |
| No. | Family name and given names | Age | Education | Address, party membership and endorsements | Number of votes | Votes % | |
| 1 | Kaźmierczak Robert | 38 | wyższe | Jarocin, submitted by KOMITET WYBORCZY WYBORCÓW ROBERT KAŹMIERCZAK ZIEMIA JAROCIŃSKA, not a member of any political party | 5 | 33,33% | |
| 3 | Martuzalski Stanisław Franciszek | 54 | średnie | Jarocin, submitted by KOMITET WYBORCZY WYBORCÓW STANISŁAWA FRANCISZKA MARTUZALSKIEGO, member of Platformy Obywatelskiej Rzeczypospolitej Polskiej | 10 | 66,67% | |
| Vote on 12-02-2012 | |
| Precinct | Precinct no. 21 |
| Electoral Commission Regional Headquarters | Szpital Powiatowy w Jarocinie Sp. z o.o., ul. Szpitalna 1, 63-200 Jarocin |
| Number of electors | 27 |
| Number of dispensed ballot cards | 2 |
| Number of valid ballot cards | 2 |
| Number of votes valid | 2 |
| Number of votes invalid | 0 |
| Number of dispensed ballot cards for plenipotentiaries | 0 |
| Protocol date | 12-02-2012 22:06 |
| No. | Family name and given names | Age | Education | Address, party membership and endorsements | Number of votes | Votes % | |
| 1 | Kaźmierczak Robert | 38 | wyższe | Jarocin, submitted by KOMITET WYBORCZY WYBORCÓW ROBERT KAŹMIERCZAK ZIEMIA JAROCIŃSKA, not a member of any political party | 1 | 50,00% | |
| 2 | Kostka Mikołaj | 30 | wyższe | Jarocin, submitted by KOMITET WYBORCZY WYBORCÓW MIKOŁAJA KOSTKI, member of Sojuszu Lewicy Demokratycznej | 0 | 0,00% | |
| 3 | Martuzalski Stanisław Franciszek | 54 | średnie | Jarocin, submitted by KOMITET WYBORCZY WYBORCÓW STANISŁAWA FRANCISZKA MARTUZALSKIEGO, member of Platformy Obywatelskiej Rzeczypospolitej Polskiej | 1 | 50,00% | |