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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000930

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of TheodoreKiec Sex Male

Date of Birth May 2, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Michael Kiec MAIDEN NAME of Mother  Niedzieski

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Sydney Present address of Father deceased

Occupation of Father at Birth of child Steelworker Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Theodore Kiec Address of Applicant South Barrington Date August 28, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of TheodoreKiec

Born at Sydney in the County of Cape Breton

That TheodoreKiec Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 2, 1920

My knowledge of the fact and date of such Birth is based on the following Circumstances:

I am the mother of this said Theodore Kiec

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