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Subscriber Data Consent Form <br />Pursuant to the Agreement between Subscriber and NEC, Subscriber hereby consents to other <br />Subscription subscribers searching and using Subscriber Data, Other Subscription subscribers use <br />or searching of Subscriber Data shall be subject to the terms and conditions of the Agreement. <br />Agency Name: <br />City of South Bend Police Department <br />Mailing Address: <br />Physical Address: <br />Phone: <br />Email. <br />Contact Person: <br />Effective Date. <br />Consent Term. <br />Subscription Expiration Dater <br />Conditions: <br />Subscriber Data includes demographic information, person ID, and face image. <br />Subscriber understands and agrees that Subscriber may revoke sharing or shorten the duration of the consent term <br />with at least 30 days' advance written notice to NEC. <br />City of South Bend Police Department <br />Authorized. Representative II <br />PWVW <br />Board <br />U: <br />Printed N rane <br />1 p1.' 1 <br />Title <br />Date <br />vl1222017 <br />