The application for a marriage license shall contain the following statement:

“The laws of this state affirm your right to enter into this marriage and at the same time to live within the marriage free from violence and abuse. Neither of you is the property of the other. Physical abuse, sexual abuse, battery, and assault of a spouse or other family member, as well as other provisions of the criminal laws of this state, are applicable to spouses and other family members and violations thereof are punishable by law. “

The application shall contain a separate line for the signatures of the applicants verifying that the applicants have read and understand the statement.