1.  The Division shall prescribe, by regulation, a statement which must be submitted to an agency that issues a professional, occupational or recreational license, certificate or permit, other than the Department of Wildlife, by an applicant for the issuance or renewal of such a license, certificate or permit.

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2.  The statement prescribed pursuant to subsection 1 must:

(a) Provide the applicant with an opportunity to indicate that:

(1) The applicant is not subject to a court order for the support of a child;

(2) The applicant is subject to a court order for the support of one or more children and is in compliance with the order or is in compliance with a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order; or

(3) The applicant is subject to a court order for the support of one or more children and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order;

(b) Include a statement that the application for the issuance or renewal of the license, certificate or permit will be denied if the applicant does not indicate on the statement which of the provisions of paragraph (a) applies to the applicant; and

(c) Include a space for the signature of the applicant.