 
| gm. Jasień, Precinct no. 4 | 
| Vote on 21-11-2010 | |
| Office | Burmistrz Jasienia | 
| Precinct | Precinct no. 4 | 
| Electoral Commission Regional Headquarters | Szkoła Podstawowa, Golin | 
| Number of electors | 831 | 
| Number of dispensed ballot cards | 429 | 
| Number of valid ballot cards | 430 | 
| Number of votes valid | 423 | 
| Number of votes invalid | 7 | 
| Number of dispensed ballot cards for plenipotentiaries | 0 | 
| Protocol date | 22-11-2010 04:43 | 
| No. | Family name and given names | Age | Education | Address, party membership and endorsements | Number of votes | Votes % | |
| 1 | Kamyszek Andrzej Roman | 48 | średnie | Jasień, submitted by KOMITET WYBORCZY FORUM SAMORZĄDOWE MIAST I GMIN POWIATU ŻARSKIEGO, not a member of any political party | 179 | 42,32% | |
| 2 | Sagasz Helena | 60 | wyższe | Jasień, submitted by KOMITET WYBORCZY POLSKIE STRONNICTWO LUDOWE, member of Polskiego Stronnictwa Ludowego | 244 | 57,68% | |