 
| gm. Gołcza, Precinct no. 5, Constituency no. 11 | |
| Council name | Rada Gminy w Gołczy | 
| Constituency | Constituency no. 11 | 
| Precinct | Precinct no. 5 | 
| Electoral Commission Regional Headquarters | Budynek po Szkole Podstawowej w Ulinie Wielkiej, Ulina Wielka | 
| Number of electors | 447 | 
| Number of dispensed ballot cards | 248 | 
| Number of valid ballot cards | 247 | 
| Number of votes valid | 242 | 
| Number of votes invalid | 5 | 
| Number of dispensed ballot cards for plenipotentiaries | 0 | 
| Protocol date | 21-11-2010 22:54 | 
| List no. 2 - KOMITET WYBORCZY POLSKIE STRONNICTWO LUDOWE | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Rolka Aleksandra Anna | 95 | 39,26% | |
| List no. 20 - KOMITET WYBORCZY WYBORCÓW RUCH OBYWATELSKI DLA GMINY GOŁCZA | ||||
| No. | Family name and given names | Number of votes | % of valid votes | |
| 1 | Dziubka Andrzej Grzegorz | 147 | 60,74% | |