RELEASE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: That, I, corporate representative and/or agent for HOLLYWOOD INJURY

REHABILIATION CENTER, INC., first party, (hereinafter the undersigned), being over the age of eighteen years old, have personally reviewed this Release Agreement (Release) and have consulted my attorney regarding said Release, and in exchange for an undisclosed sum and other valuable consideration, the receipt of the foregoing from SECURITY NATIONAL INSURANCE COMPANY, the second party, being hereby acknowledged by the undersigned, hereby release, acquit, and forever discharge, SECURITY NATIONAL INSURANCE COMPANY, its heirs, successors, executors, agents, administrators, trustees, and/or its parent company, the second party, from any and all suits, causes of action, demands, proceedings, and/or claims, known or unknown, that the first party, has or may have in the future, against SECURITY NATIONAL INSURANCE COMPANY related to, or arising out of the January 7, 2002 accident that occurred in Broward County, Florida. The undersigned understands the terms and conditions of this Release, and understands and agrees that this settlement is the compromise of doubtful and disputed claim(s) and that the payment made is not be construed as an admission of liability, or confession of judgment on the part of the party or parties hereby released, and that said Release denies liability therefore and intend merely to avoid litigation and resolve and conclude the aforementioned matter. The undersigned understands and agrees that this Release and settlement of this matter is made without reliance upon any statement or representation of the party or parties, and that no promise, inducement or agreement not herein expressed has been made to the undersigned, and that this Release contains the entire agreement between the parties hereto, and that the terms and conditions of this Release are contractual in nature and not a mere recital. The undersigned has the authority to enter into and bind HOLLYWOOD INJURY REHABILIATION CENTER, INC., to the terms and conditions stated within this Release. In the event that the undersigned does not have the authority to enter into and bind HOLLYWOOD INJURY REHABILIATION CENTER, INC., to the terms and conditions of this Release as stated herein, the undersigned hereby agrees to defend, indemnify and hold harmless SECURITY NATIONAL INSURANCE COMPANY, from any claims, causes of actions, suits, proceedings, or any other matters related to or arising from this Release and the authority stated hereunder. The undersigned represents that they and their attorneys ALONE are entitled to the settlement funds and that there are NO LIENS or CLAIMS made to these funds by any other party or person, natural or corporate, including any claims made by any

insurance carrier for PIP benefits; workmen's compensation benefits; medical payments benefits and property damage. The undersigned hereby agree to DEFEND, INDEMNIFY and HOLD HARMLESS SECURITY NATIONAL INSURANCE COMPANY, its heirs, successors, executors, agents, administrators, trustees, and/or its parent company, the second party from ANY and ALL claims and/or liens and/or subrogated interests herein for which these funds are intended. IN WITNESS WHEREOF, I have hereunto set my hand and seal this _____ day of January, 2003. Signed, sealed and delivered in presence of: _________ WITNESS ___________________________________ HOLLYWOOD INJURY REHABILIATION CENTER, INC. Title:______________________________ Print Name: _________________________

STATE OF FLORIDA COUNTY OF ____________ I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared ___________ ______________________, (who is personally known to me) (who has produced as identification) and who executed the foregoing instrument and acknowledged before me that he/she executed the same. WITNESS my hand and official seal in the County and State this ________________, 2003 day of

______________________ NOTARY PUBLIC This instrument prepared by: Jacob C. Jackson, Esq.
LAW OFFICES OF RICHARD M. NELSON Attorneys for Security National Insurance Company P.O. Box 22-1710 Hollywood, Florida 33022-1710 Phone: (954) 316-5290 Fax: (305) 316-5297