 
| gm. Jasień, Precinct no. 3, Constituency no. 5 | |
| Council name | Rada Miejska w Jasieniu | 
| Constituency | Constituency no. 5 | 
| Precinct | Precinct no. 3 | 
| Electoral Commission Regional Headquarters | Szkoła Podstawowa, Wicina | 
| Number of electors | 450 | 
| Number of dispensed ballot cards | 189 | 
| Number of valid ballot cards | 189 | 
| Number of votes valid | 181 | 
| Number of votes invalid | 8 | 
| Number of dispensed ballot cards for plenipotentiaries | 0 | 
| Protocol date | 22-11-2010 01:57 | 
| List no. 12 - KOMITET WYBORCZY FORUM SAMORZĄDOWE MIAST I GMIN POWIATU ŻARSKIEGO | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Tracz Dorota Stanisława | 71 | 39,23% | |
| List no. 13 - KOMITET WYBORCZY WYBORCÓW NASZA GMINA JASIEŃ | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Chorab Jadwiga | 110 | 60,77% | |