I believe your "unlisted" is a court delivery fee, possibly from 1912. I base this on one of mine that was identified by nigelc on another board. The colors of the underprints look a little different, but without more information, I'm ascribing that to the difference between scans.
This is from one of a set of three documents (birth, marriage) from Riga Latvia in the 1890's (then a part of the Russian Empire). They belonged to my great grandparents who brought them with them when they immigrated to the USA in the first decade of the 1900's.